Ophthalmology Research: An International Journal

4(3): 93-98, 2015, Article no.OR.2015.035

ISSN: 2321-7227

SCIENCEDOMAIN international
www.sciencedomain.org

Conjunctival Foreign Body a Rare Presentation

Tarakeswararao Attada1* and V. V. L. Narasimha Rao1
1
Department of Ophthalmology, Andhramedical College, Govt. Regional Eye Hospital,
Visakhapatnam, Andhra Pradesh, India.

Authors’ contributions

This work was carried out in collaboration between both authors. Both authors read and approved the
final manuscript.

Article Information

DOI: 10.9734/OR/2015/18395
Editor(s):
(1) Li Wang, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, USA.
Reviewers:
(1) Saka Eletu Sadiat, Department of Ophthalmology, Federal Medical Centre, Nigeria.
(2) Anonymous, University of Sao Paulo, Brazil.
(3) Anonymous, Ahi Evran University, Turkey.
(4) Sagili Chandarsekhara Reddy, Department of Ophthalmology, National Defence University of Malaysia,
Malaysia.
Complete Peer review History: http://sciencedomain.org/review-history/9797

Received 20th April 2015

st
Case Report Accepted 1 June 2015
th
Published 16 June 2015

ABSTRACT

Aim: Detection of subconjunctival or intra orbital wooden foreign bodies and its retrieval is
important, because of severe blinding complications secondary to infection can occur. We describe,
a case of post traumatic subconjunctival wooden foreign bodies retained in conjunctival culde-sac
of upper fornix, presenting as conjunctival granuloma.
Case Report: A 50 year male patient was accidentally hit by a wooden stick on the right eye 25
days ago, while he was working in the paddy field. On examination, a granulomatous growth was
present on the temporal side of the bulbar conjunctiva. Two wooden foreign bodies were removed
from the conjunctival granulomatous mass.
Discussion: The superficial foreign bodies of the conjunctiva are common and the ocular
protective mechanisms normally extrude superficial foreign bodies. The clinical course of orbital
foreign bodies depends upon their composition. The organic foreign bodies like wood if left
untreated results in sight threatening complications.
In our case, wooden foreign bodies penetrated subconjunctivally into the upper fornix and
presented as conjunctival granuloma. Under topical anaesthesia (xylocaine 4%) two wooden
foreign bodies were removed from conjunctival granuloma. The patient recovered uneventfully with
antibiotic drops and oral analgesics and anti-inflammatory drugs.

_____________________________________________________________________________________________________

*Corresponding author: E-mail: tarakeye@gmail.com;

 Attada and Rao; OR, 4(3): 93-98, 2015; Article no.OR.2015.035

Conclusion: In patients presenting with post traumatic conjunctival granuloma, we should strongly
suspect a subconjunctival retained foreign body before initiating treatment.

Keywords: Conjunctiiva; granulation tissue; foreign body; growth; wood.

1. INTRODUCTION was not solved. He presented to our hospital

Conjunctival foreign bodies of the eye are
common. Wooden ocular foreign bodies are
common in rural areas particularly in agricultural
workers. Most of the times, foreign bodies are
small particles of dust, stone piece, insect wing
or small iron particles. Foreign bodies may settle
on the bulbar conjunctiva, upper or lower fornix
or on the cornea but most commonly retained in
the upper conjunctival cul-de-sac. Sometimes
wooden foreign bodies penetrate and are
retained under the conjunctiva. In due course the
foreign bodies are covered by granulation tissue
which may simulate the cockscomb type of
tuberculosis of conjunctiva [1]. This is a rare
presentation of the conjunctival foreign body.
2. CASE REPORT
A 50 years male patient who is an agricultural
worker, came with a complaint of redness, pain,
foreign body sensation and discharge of right eye
for the last 25 days. He was accidentally hit by a
wooden stick on the right eye 25 days ago while
he was working in the paddy field. Then he was
treated by antibiotic eye drops and pain killers by
local doctors for about 20 days, but the problem
outpatient Department.
On examination of the Right eye there was mild
upper lid oedema. A pedunculated polyp like
growth was present on the temporal side of the
bulbar conjunctiva. The growth was not attached
to the cornea. Cornea was clear and fluorescein
stain was negative. Anterior chamber was of
normal depth with clear contents, pupil was
reacting to light. Fundus examination was within
normal limits except a few lenticular opacities.
Visual acuity was 6/18 in Right eye. The left eye
was found normal and visual acuity was 6/9.
On careful examination of the right eye there
were two small yellowish white spots noticed on
the surface of the polyp like growth of the
conjunctiva which appeared like pus points
(Fig. 1). Under topical anaesthesia (4%
lignocaine) the surface of the growth was
manipulated with plain forceps by which it was
found that those points are actually the tips of
wooden foreign bodies (Fig. 2). Two pieces of
wooden foreign bodies were removed from the
pedunculated growth of the conjunctiva, one
foreign body was measuring about 2cm and
other one about 4 cm (Fig. 3. Fig. 4). There were
no signs of perforation of the globe.

Fig. 1. Pus like points of foreign bodies

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 Attada and Rao; OR, 4(3): 93-98, 2015; Article no.OR.2015.035
Fig. 2. Projected foreign bodies from conjunctivalgranuloma
Moxifloxacin eye drops 6times per day and tab
aceclofen two times per day for 5 days was
prescribed. All inflammatory signs and
conjunctiva granulation markedly reduced within
one week. Patient’s vision in right eye improved
to 6/9 by the end of one week.
3. DISCUSSION
The superficial foreign bodies of the conjunctiva
are common, such as small particles of dust or
steel and insect wings [2]. These foreign bodies
impinge on the cornea or conjunctiva [1]. Ocular
protective mechanisms which include blinking
and tearing normally remove superficial foreign
body that comes in contact with the ocular
surface. [3]
The orbital foreign bodies are divided in to three
types [4] 1. Metallic. 2. Non-organic like glass
pieces. 3. Organic foreign bodies like wood. The
clinical course of the foreign bodies depends
upon their composition [5]. Some metallic foreign
bodies remain quiescent for long period of time
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without causing any problems. But organic
foreign bodies like wood cause sight threatening
complications. They may remain asymptomatic
for variable periods and manifest with delayed
onset of conjunctival granuloma, cellulitis and
abscess. When a foreign body with large surface
area gets lodged in the conjunctiva, initially, there
is an acute inflammatory response in the form of
exudation of plasma and fibrin and the foreign
body becomes embedded. This is followed by a
chronic inflammatory response resulting in the
formation of granuloma [2]
In our case, wooden foreign bodies penetrated
subconjunctivally into the upper fornix and in due
course covered by granulation tissue, presented
as pedunculated conjunctival growth which
simulated cockscomb type tuberculosis of the
conjunctiva [1]. Occasionally, as in our case,
foreign body retained in the fornix, encapsulated
by mucus, embedded in the Underlying stroma
may cause local inflammatory response. In case
of conjunctival foreign bodies, we must search
for signs of globe perforation.
 Attada and Rao; OR, 4(3): 93-98, 2015; Article no.OR.2015.035

Fig. 3. Removed wooden foreign bodies Fig. 4. Measurement of foreign bodies

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 Attada and Rao; OR, 4(3): 93-98, 2015; Article no.OR.2015.035

An intraorbital foreign body is an object that lies agricultural field with history of trauma, a retained
within the orbit but outside the ocular globe [4]. In conjunctival wooden foreign body should be
the literature they reported evidence of orbital ruled out first [10].
foreign body migration toward the cranium [6].
So, it is important to identify and remove In conclusion, we would like to emphasize that
intraorbital wooden foreign bodies as early as with meticulous ocular examination and good
possible to prevent further complications. clinical acumen we can avoid vision threatening
complications because of retained foreign bodies
Identification or localization and removal of Intra and eye care professionals should keep in mind
orbital wooden foreign body poses a challenge to a retained foreign body as a differential diagnosis
the ophthalmologist. He has to use appropriate when dealing with inflamed conjunctival growths.
imaging modality for evaluation of intra orbital
wooden foreign body. Plain X- ray has limited CONSENT
role in the diagnosis of intraorbital wooden
foreign body. The detection rate of plain X-ray is A written informed consent taken from the
very low (0-15%) [7]. B-scan Ultrasonography patient.
has a very limited role in localization of
intraorbital wooden foreign body. The CT- Scan ETHICAL APPROVAL
findings of intraorbital wooden foreign body are
variable and may be similar to orbital fat and It is not applicable.
muscle. The MRI scan is better at demonstrating
intra orbital wooden foreign bodies [8,9]. It can ACKNOWLEDGEMENTS
distinguish between air and wood easily.
Sincere thanks to Dr. V.V.L Narasimha Rao MS,.
In our case, there was definite history of injury Our Professor and Supt. Govt. Regional Eye
with wooden stick present. The tips of wooden Hospital. Visakhapatnam AP.
foreign bodies were visible on manipulation of
conjunctival granulomatous mass. Therefore COMPETING INTERESTS
imaging investigation was not done to locate
foreign body. Authors have declared that no competing
interests exist.
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© 2015 Attada and Rao; This is an Open Access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Peer-review history:
The peer review history for this paper can be accessed here:
http://sciencedomain.org/review-history/9797

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